Wait before cutting cord

Delaying cutting the once life-giving cord, rather than clamping it immediately, results in better blood counts and iron levels for a baby, according to the meta-analysis - or study of previous studies - that appears in the March 21 issue of the Journal of the American Medical Association.

More studies are needed
Still, experts not involved with the new research are divided on the advisability of adopting the practice of a delayed cutting but agree more research is needed before clinical changes are recommended.

"There are no real practical implications here, and the study authors themselves indicate that more studies are needed," said Dr Salih Yasin, associate chairman of obstetrics and gynaecology at the University of Miami Miller School of Medicine.

"The studies hint that baby has better iron storage and is less likely to get anaemic (with late clamping), so that should be important to paediatricians," added Dr Cheryl Cipriani, associate professor of paediatrics at the Texas A&M Health Science Centre and paediatric neonatologist at Scott & White Hospital. "I personally think that this might make many physicians do something in between (early and late clamping) and design a large, multi-centre study. Maybe it's time to review what we do."

Differences on exact timing
The umbilical cord, which connects a foetus to the mother during pregnancy, is almost always cut at birth in developed nations. But the exact timing for the cutting is a subject of some debate.

In the absence of formal guidelines, most health-care practitioners in the developed world cut the cord immediately after birth, both to avoid respiratory problems and to facilitate bonding between mother and child. In the developing world, the timing is much more variable with a tendency toward late clamping to counter a high risk of anaemia in those regions.

Today, there are also questions concerning banking of umbilical cord blood, because it can provide stem cells that would be a match for the baby. "More and more parents are doing this," Cipriani said. "Only about half the time when you collect umbilical cord blood do you have enough for that banking."

One recent review showed that delayed clamping resulted in a decreased need for blood transfusion and lower risk of haemorrhage. Other studies, however, didn't find either approach to be vastly superior. Some studies have found that a slight delay in cord clamping is beneficial for preterm infants.

The new study involved no new research but, instead, was a meta-analysis of previous trials comparing late to early cord clamping in infants born full-term. Late clamping took place at least two minutes after birth, while early clamping, in most trials, occurred immediately after birth.

Reduced risk of anaemia
Late clamping improved the blood count and iron status of the babies and reduced the risk of anaemia. The practice sometimes resulted in polycythemia, or too many red blood cells, but the condition appeared to be temporary, the study authors said.

For some experts, however, the conclusions aren't definitive.

"This is nice work, it's an exhaustive analysis with twists and kinks in it, but the bottom line seems to be that there really is no clear harm or benefit from either early or late clamping," Yasin said. – (HealthDayNews)

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Birth Centre
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March 2007